Connecticut Medicaid P&T Meeting Minutes September 2, 2010 The meeting started at 6:30 pm Attendance Present Members: Carl Sherter, MD Peggy Manning Memoli, Pharm D Eric Einstein, MD Ezra Griffith, MD Manage Nissanka, MD Lawrence Sobel, RPh Emmett Sullivan, RPh Elizabeth Rodriguez, RN Stella Cretella DSS: Evelyn Dudley Jim Zakszewski, RPh HP/Provider Synergies Chris Andrews, Pharm D Joy DeNardo, RPh Melissa Chandler, CPhT. Absent Members: Richard Carbray, Jr. RPh Hilda Slivka, MD Charles Thompson, MD Tsampika (Beka) Apostolidis Opening remarks: Evelyn Dudley made the following announcements: Connecticut discontinued the ConnPACE/SAGA PDL 6/30/10. The SAGA population was transitioned into the Medicaid Fee-for-Service program. Approval of minutes: Committee members approved the meeting minutes from the June 3, 2010 meeting. Public Presentations: Damian Gasparotto, PharmD of GlaxoSmithKlein addressed the committee regarding the use of the BPH Agent, Jalyn. Anna Tallman, PharmD of Strativa Pharmaceuticals addressed the committee regarding the use of the Oral Antifungal, Oravig. New Generics: Chris Andrews informed the committee members regarding the following new generic products: The generics for Amerge (naratriptan), Astelin (azelastine), Differin (adapalene), Effexor XR (venlafaxine ER), Exelon (rivastigmine), Methylin (methylphenidate), Tarka (trandolapril/verapamil) and Zegerid (omeprazole/sodium bicarbonate) were recommended to be non-preferred products. The Committee motioned to approve and accept Provider Synergies recommendations. The motion was
Therapeutic Class Reviews: Chris Andrews, from Provider Synergies, presented clinical data and financial analysis, as well as answered questions from committee members on the following fourteen therapeutic classes. Outcomes and votes are recorded below by class: Antifungals, Oral Chris Andrews presented the evaluation and recommendation for this class. He noted that Terbinex and Oravig are new products to this class. There were no recommended changes to this class for the Medicaid PDL. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL with Larry Sobel seconding. The motion was clotrimazole, fluconazole, griseofulvin suspension, Gris-Peg, ketoconazole, nystatin, terbinafine OFF Medicaid PDL: Ancobon, Diflucan, Grifulvin V, itraconazole, Lamisil granules, Lamisil tablets, Mycostatin, Noxafil, Oravig, Sporanox, Terbinex, Vfend Antifungals, Topical this class for the Medicaid PDL. Larry Sobel motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL with Dr. Einstein seconding. The motion was ciclopirox cream/gel/suspension, clotrimazole Rx, clotrimazole/betamethasone, econazole, ketoconazole cream/shampoo, Naftin, nystatin, nystatin/triamcinolone OFF Medicaid PDL: Bensal HP, ciclopirox solution/shampoo, CNL-8, Ertaczo, Exelderm, Extina, Ketocon + Plus, Lamisil, Loprox, Lotrisone, Mentax, Nizoral, Oxistat, Penlac, Vusion, Xolegel Antimigraine Agents Chris Andrews presented the evaluation and recommendation for this class. The class has been expanded to include products other than Triptans, so that distinction has been removed from the therapeutic class name. He noted that Cambia is a new product to this class indicated for the acute treatment of migraine attacks with or without aura. The recommended changes to this class for the Medicaid PDL would be the addition of Frova, Relpax and sumatriptan tablets and the removal of Imitrex tablets. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL with Emmett Sullivan seconding. The motion was passed unanimously. Frova, Imitrex (nasal, injectable), Relpax, sumatriptan (oral) OFF Medicaid PDL: Amerge, Axert, Cambia, Imitrex (oral), Maxalt/Maxalt MLT, naratriptan, sumatriptan (nasal, injectable), Sumavel Dosepro, Treximet, Zomig/Zomig ZMT (oral, nasal)
Antivirals, Oral Chris Andrews presented the evaluation and recommendation for this class. He noted Valtrex is now available as a generic, valacyclovir. There were no recommended changes to this class for the Medicaid PDL. Stella Cretella motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL with Larry Sobel seconding. The motion was acyclovir, amantadine, Relenza, rimantadine, Tamiflu, Valtrex OFF Medicaid PDL: famciclovir, Famvir, Flumadine, valacyclovir, Zovirax Bladder Relaxant Preparations been no new significant information pertaining to this class. The recommended changes to this class for the Medicaid PDL would be the addition of Sanctura XR and Toviaz. Larry Sobel motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL as presented with Stella Cretella seconding. The motion was Detrol LA, Enablex, oxybutynin, Sanctura XR, Toviaz, VESIcare OFF Medicaid PDL: Detrol, Ditropan, Ditropan XL, Gelnique, oxybutynin ER, Oxytrol, Sanctura, trospium BPH Agents Chris Andrews presented the evaluation and recommendation for this class. He noted that Flomax is now available as a generic. There were no recommended changes for this class for the Medicaid PDL. Stella Cretella motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL as presented with Dr. Einstein seconding. The motion was Avodart, doxazosin, Flomax, Proscar, terazosin, Uroxatral OFF Medicaid PDL: Cardura, Cardura XL, finasteride, Jalyn, Rapaflo, tamsulosin Cephalosporins and Related Antibiotics Chris Andrews presented the evaluation and recommendation for this class. He noted that Augmentin XR and Spectracef are now available as generics and cefuroxime suspension is no longer available. There were no recommended changes for this class for the Medicaid PDL. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL with Larry Sobel seconding. The motion was amoxicillin/clavulanate tablets/suspension, cefaclor, cefadroxil, cefdinir, cefpodoxime, cefprozil, cefuroxime, cephalexin, Suprax OFF Medicaid PDL: amoxicillin/clavulanate XR, Augmentin tablets/suspension, Augmentin XR, Cedax, cefditoren, Ceftin, Spectracef
Fluoroquinolones, Oral Chris Andrews presented the evaluation and recommendation for this class. He noted that Factice is now owned by Cornerstone. There were no recommended changes to this class for the Medicaid PDL. Larry Sobel motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL as presented with Stella Cretella seconding. The motion was Avelox, ciprofloxacin OFF Medicaid PDL: Cipro suspension, Cipro tablets, ciprofloxacin ER, Factive, Levaquin, Noroxin, ofloxacin, Proquin XR Glucocorticoids, Inhaled Chris Andrews presented the evaluation and recommendation for this class. He noted that the promotion and manufacturing of Azmacort was discontinued in December 2009. He also noted that Dulera is a new product to this class indicated for the treatment of asthma in patients 12 years and older. The recommended change to this class for the Medicaid PDL would be the addition of Dulera as preferred. Stella Cretella motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL as presented with Larry Sobel seconding. The motion was Advair/Advair HFA, Aerobid/Aerobid-M, budesonide respules, Dulera, Flovent/Flovent HFA, Pulmicort respules, QVAR, Symbicort OFF Medicaid PDL: Alvesco, Asmanex, Pulmicort flexhaler Hepatitis C Agents this class for the Medicaid PDL. Emmett Sullivan motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL as presented with Larry Sobel seconding. The motion was Pegasys, Peg-Intron, Peg-Intron RediPen, ribavirin OFF Medicaid PDL: Copegus, Infergen, Rebetol Hypoglycemics, Meglitinides this class for the Medicaid PDL. Emmett Sullivan motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL as presented with Larry Sobel seconding. The motion was Prandin, Starlix OFF Medicaid PDL: nateglinide, Prandimet
Macrolides & Ketolides this class for the Medicaid PDL. Larry Sobel motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL as presented with Stella Cretella seconding. The motion was azithromycin, clarithromycin/clarithromycin ER, erythromycin OFF Medicaid PDL: Biaxin, Biaxin XL, Ery-Tab, Ketek, PCE, Zithromax, Zmax Pulmonary Arterial Hypertension (PAH) Agents, Oral & Inhaled Chris Andrews presented the evaluation and recommendation for this class. He noted that the inhaled agents are being added to this class. He also noted that Adcirca is a new product to this class indicated for the treatment of PAH to improve exercise ability. The recommended changes to this class for the Medicaid PDL would be the addition of Adcirca and Ventavis. Dr. Einstein motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL as presented with Stella Cretella seconding. The motion was Adcirca, Letairis, Revatio, Ventavis OFF Medicaid PDL: Tracleer, Tyvaso Sedative Hypnotics Chris Andrews presented the evaluation and recommendation for this class. He noted that Edluar is a new product to this class indicated for the short-term treatment of insomnia. There were no recommended changes to this class for the Medicaid PDL. Stella Cretella motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL as presented with Dr. Einstein seconding. The motion was chloral hydrate, Doral, estazolam, flurazepam, Restoril 7.5mg, temazepam, triazolam, zolpidem OFF Medicaid PDL: Ambien, Ambien CR, Edluar, Halcion, Lunesta, Restoril (except 7.5mg), Rozerem, Silenor, Sonata, zaleplon
Recommendations for next class reviews: Provider Synergies recommended the following classes be reviewed at the next P&T meeting: Angiotensin Modulator/CCB Combinations Analgesics/Anesthetics, Topical Antibiotics, GI Antibiotics, Vaginal Bronchodilators, Anticholinergic Bronchodilators, Beta Agonist Hypoglycemics, Insulins and Related Leukotriene Receptor Antagonists Ophthalmic Antibiotics Ophthalmics, Allergic Conjunctivitis Ophthalmics, Glaucoma Pancreatic Enzymes Phosphate Binders Platelet Aggregation Inhibitors Schedule next meeting: Committee members agreed on Thursday, December 2, 2010 for the next P & T meeting. Meeting adjourned at 6:56pm
Addendum to 9/2/10 Minutes Connecticut has Joined Provider Synergies The Optimal Preferred Drug List (PDL) $olutionsm (TOP$SM) Program. Connecticut has elected to become the most recent addition to the Provider Synergies L.L.C. multi-state initiative, TOP$SM (The Optimal PDL $olutionsm). TOP$SM is Provider Synergies multistate pool for the PDL that includes the following states: DE, MD, LA, ID, NE, PA, and WI. The intent of the PDL is to achieve quality pharmaceutical care for clients served by the Department's Medical Assistance Programs while providing optimal state savings. Connecticut s participation in TOP$SM will improve the Department s Medical Assistance Program s clinical and financial performance by acting in concert with other states. Due to Connecticut s recent decision to join TOP$SM, the therapeutic classes originally identified at the end of the 9/2/10 Pharmaceutical and Therapeutics (P&T) Committee meeting will not be reviewed at the 12/2/10 meeting. Instead, Connecticut will review the products within the TOP$SM therapeutic categories listed below at the 12/2/10 meeting, which are new PDL classes to Connecticut. DECEMBER 2010 THERAPEUTIC CATEGORIES ANDROGENIC AGENTS ANTIBIOTICS, INHALED ANTIEMETICS ANTIVIRALS, TOPICAL COLONY STIMULATING FACTORS H. PYLORI AGENTS OPHTHALMIC ANTIINFLAMMATORIES PANCREATIC ENZYMES STEROIDS, TOPICAL - HIGH POTENCY STEROIDS, TOPICAL - LOW POTENCY STEROIDS, TOPICAL - MEDIUM POTENCY STEROIDS, TOPICAL - VERY HIGH POTENCY TETRACYCLINES, ORAL Connecticut will assume the 2011 TOP$SM class review schedule following the December P&T meeting, and meeting dates for the 2011 P&T Committee meetings will be determined during that meeting. The 2011 P&T Committee Meeting Schedule will be posted to the Pharmaceutical and Therapeutics Committee Section of the Pharmacy Information Page on the Web site.